Letters to the Editor Actas Dermosifiliogr. 2008;99:493-501 498 3. Requena L (ed.). Neoplasias anexiales cutáneas. Madrid: Ed. Aula Médica; 2004. p. 89-93. 4. Abenoza P, Ackerman AB (eds.). Neoplasms with eccrine differentiation. Philadelphia: Lea & Febiger; 1990. p. 113-85. 5. Utako O, Hiroyuki H, Hiroyuki S. Pigmented eccrine poroma occurring on the scalp: derivation of melanocytes in the tumor. Am J Dermatol. 2006;28: 138-41. 6. Pylyser K, Dewolf-Peeters C, Marien K. The histology of eccrine poromas: a study of 14 cases. Dermatologica. 1983; 167:243-9. 7. Altamura D, Piccolo D, Lozzi GP, Peris K. Eccrine poroma in an unusual site: a clinical and dermoscopic simulator of amelanotic melanoma. J Am Acad Dermatol. 2005;53:538-40. Low-Dose Isotretinoin For Treatment of Chronic Discoid Lupus in Women of Childbearing Age M. Pérez-Crespo, J. Bañuls, J. Mataix, and A. Lucas Servicio de Dermatología, Hospital General Universitario de Alicante, Spain To the Editor: We present the case of a 29-year-old woman diagnosed with systemic lupus erythematosus in 1988 on the basis of malar erythema, photosensitivity, arthralgia, thrombocytopenia, lymphopenia, and positive results for antinuclear and anti-DNA antibodies. She consulted in August 2004 with multiple erythematous plaques with atrophic centers on the upper region of the trunk and face, along with erythematous lesions with a hyperkeratotic appearance on both palms (Figure 1), with onset several months previously. Both types of lesion were compatible with lupus. At the time of consultation the patient was being treated with prednisone, mycophenolate, and chloroquine, without improvement in the cutaneous lesions. Treatment was prescribed with isotretinoin 40 mg/d, with agreement from the patient to use effective means of contraception. A rapid response was observed and the drug was well tolerated, so treatment was maintained for 6 months. The palmar lesions reappeared from 1 month after the drug was withdrawn. Topical treatment was administered for approximately a year to no effect, leading to initiation of treatment with isotretinoin at a dose of 20 mg/d in order to reduce the toxicity of the treatment. A slower improvement was seen with the new dosage, although from the fifth month of treatment the results were similar to those seen at the end of the 40 mg/d cycle (Figure 2). The lesions remained stable for 12 months, with no significant changes in triglycerides or hepatic enzymes. The patient used safe methods of contraception during the treatment period. There were no side effects apart from cheilitis and slight xerosis on the face. Chronic discoid lesions are one of the most common forms of cutaneous lupus erythematosus. 1 These are most commonly found on the face, scalp, and the ears, although palmar lesions are also possible. Chronic discoid lupus erythematosus can be treated with various topical drugs, like potent corticosteroids, 2 or imiquimod 5%, 3 as well as systemic treatments like thalidomide, hydroxychloroquine, or acitretin. The last 2 are first-line drugs with similar levels of effectiveness, 2 although acitretin has more associated side effects. Side effects include cutaneous xerosis, cheilitis, gastrointestinal disorders, increased serum levels of triglycerides, and high risk of teratogenic effects, which oblige patients to use contraceptive measures during treatment and for 2 years after the drug is discontinued. Meanwhile, isotretinoin has been shown to be effective in the treatment of chronic discoid lupus erythematosus, and it can also be employed as a maintenance treatment at doses of 40 mg on alternate days. 4 This treatment has similar side effects to acitretin but a lower risk of teratogenesis, which means that female patients prescribed the drug need only take contraceptive measures during treatment and for a month after this is suspended. In the case described here, the patient was planning a pregnancy in the medium term, whereby acitretin was rejected in favor of isotretinoin. Figure 1. Hyperkeratotic erythematous lesions on both palms. Figure 2. Improvement of lesions following 5 months of treatment with isotretinoin (20 mg/d).